Causes of Fever and Neutropenia

Chemotherapy

Chemotherapy is the most common cause of a weakened immune system and a decreased number of RBCs, WBCs, and platelets. When chemotherapy is given, the drug destroys both normal and cancer cells. Normal cells in the body most affected by chemotherapy include your hair follicles, the cells that line your mouth and GI tract, and your bone marrow cells.

How much the chemotherapy affects your body depends on:

• The chemotherapy drugs you receive
• The dose you receive
• The schedule of your treatment
• Other treatments given for your cancer
• Your age
• Your nutrition
• Your type of cancer
• The stage of your cancer

Some drugs can lower your blood neutrophils more than others. But the effect on your blood cells is temporary and your blood cell counts will return to normal as your bone marrow produces new cells.

Radiation Therapy

Radiation therapy can also destroy normal cells in your body. Unlike chemotherapy that treats your whole body, radiation affects only the area being treated. If bones where blood cells are made and stored are in the area that is treated by radiation, then your blood cells will be affected.

Factors that can affect your blood cells are:

• The amount of radiation you receive
• Your radiation schedule
• How much of your body is treated with radiation

Radiation therapy can damage the skin and mucous membranes, making them less able to keep germs out of your body. Today, radiation treatments are given over many sessions rather than in one large dose. This helps to decrease the effect on your blood, skin, and mucous membranes, and the chance infection.

Immunotherapy

The purpose of immunotherapy, also known as biotherapy, is to help the immune system find and attack cancer cells. Although these treatments affect cancer cells, they can also cause a decrease in your blood neutrophils.

Transplants

Stem cell transplant (SCT) is the term now used to include bone marrow transplants (BMTs) and those transplants done with stem cells found in the blood. These treatments use very high doses of chemotherapy and/or total body irradiation (TBI) to kill the cancer cells. In killing the cancer cells, normal stem cells of the patient's bone marrow are also killed. Stem cells removed from the patient before chemotherapy or stem cells taken from a donor are used to replace these cells after the chemotherapy and radiation are completed. High doses of chemotherapy, sometimes given with TBI, often cause severe neutropenia that lasts for more than a week. These treatments, when used together, may also greatly reduce the skin and mucous membrane’s ability to keep germs out of the body.

Signs and Symptoms of an Infection

An infection is a very common and it can be a very serious effect of cancer treatment. When present, the infection can cause certain signs or symptoms that let you know something is not right. These symptoms can help you and your doctor know which part of the body is affected by the infection. You will want to know and watch for the early signs of infection, so that you can notify your doctor right away.

Fever is important because it is a body defense and often the first sign of an infection. But as your neutrophil count drops, the normal signs of infection, such as pus from a wound, and inflammation (pain, swelling, and redness) may be absent. If you have a very low neutrophil count, fever may be the only sign of an infection The longer the neutropenia is present and the lower the neutrophil count, the greater your chance of a serious infection. Therefore, if you have a fever, you should see a doctor immediately.

Most patients are asked to call their doctor or nurse if they have a fever greater than 100.5° F or if they have other signs and symptoms of infection. Be sure you know when to call your doctor or nurse and how to reach them after office hours and on weekends

Being at Risk for Infection

Because you have cancer, you are more likely to have an infection than others. If your cancer treatment causes neutropenia, then you have a greater chance of having an infection. And when your neutrophil count is low, other factors affect your risk for infection.

Your risk for a serious infection is greater if your neutrophil count is low and you:

• Are in the hospital when your fever starts
• Have other serious illnesses
• Have cancer that is not controlled or  is progressing
• Have a very low neutrophil count (100 or less) for a week or more
• Have pneumonia (lung infection) or other serious infection
• Are 60 years of age or older
• Have had a recent stem cell transplant
• Have abnormal liver and/or kidney function
• Are dehydrated or your blood pressure is low
• Have emphysema or other chronic obstructive pulmonary (lung) disease (COPD)

You are at a lower risk for a serious infection if your neutrophil count is low and you:

• Have none of the high-risk factors above
• Are expected to have neutropenia for less than a week
• Are generally able to perform your daily activities for yourself

INTRODUCTION

TYPES OF INFECTIONS

For more information on these treatment guidelines, or on cancer in general, call the NCCN at 1-888-909-NCCN or the American Cancer Society at 1-800-ACS-2345. Or you can visit these organizations’ web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

© 2006 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.